Corpus callosum infarction: radiological and histological findings
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LETTER TO THE EDITORS
Corpus callosum infarction: radiological and histological findings Stefano Gelibter1 · Angela Genchi1 · Marcella Callea2 · Nicoletta Anzalone3,4 · Sebastiano Galantucci1 · Maria Antonietta Volonté1 · Massimo Filippi1,4,5,6 Received: 22 June 2020 / Revised: 7 September 2020 / Accepted: 8 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Sirs, Corpus callosum (CC) infarction is an uncommon event among ischemic strokes, most likely due to a rich blood supply [1, 2]. The clinical presentation may be characterized by slow evolving symptoms, often lacking of localizing features. Furthermore, radiological findings are sometimes misleading. Clinical and radiological findings, along with the paucity of reported cases, might make differential diagnosis challenging and occasionally prompt biopsy [2]. Herein, we report a case of CC infarction whose clinical and radiological presentation prompted a biopsy and we discuss the diagnostic challenge and the role of follow-up imaging studies. A 67-year-old woman presented with a subacute onset of confusion, drowsiness and malaise followed by the slow development of expressive aphasia and right hemiparesis over the following five days. The patient was known for type 2 diabetes, without other significant comorbidities. No history of fever or other systemic symptoms were reported. A brain CT was performed (not shown), revealing a hypodense lesion involving the left part of the genu of CC with a mild mass effect on frontal horn of left lateral ventricle. Brain MRI performed ten days after symptom onset confirmed
* Massimo Filippi [email protected] 1
Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
2
Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
3
Neuroradiology Unit and CERMAC, IRCCS San Raffaele Scientific Institute, Milan, Italy
4
Vita-Salute San Raffaele University, Milan, Italy
5
Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
6
Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
the presence of a T2/FLAIR hyperintense area involving the genu and the body of CC (Fig. 1a, d, e), with restricted diffusion (Fig. 1b, f), patchy contrast-enhancement (Fig. 1b, f), edema and mass effect on frontal horn of left lateral ventricle (Fig. 1a, e), with concomitant diffuse vasculopathy. Considering the encephalopathic onset, the slow evolving development of localizing symptoms and the neuroimaging findings, the following differential diagnoses were taken into account: cerebral vasculitis, lymphoproliferative disorder and infarction of the CC. Extensive blood tests, including an autoimmune-antibody screening, were normal. CSF cells, glucose and protein were within normal range. Oligoclonal bands were negative and no infective pathogen was detected. The encephalopathic features and the evolving nature of symptoms were not easily reconcilable w
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